START Triage

START Triage : Sorting of Patients

1. You can’t commit to “one-on-one” care 
2. You have to be fast – 30 sec or less per patient 
3. Very limited treatment is provided 

• Manually open airways 
• Clear airway with finger sweep 
• Control major bleeding Primary and Secondary Triage

Primary and Secondary Triage

1. Primary triage

• 1st contact 
• Assign triage category 

2. Secondary triage

• Ongoing process that takes place after the patient has been moved to a treatment/holding area awaiting transport.

Triage Categories :

The “START” System of Triage Simple triage and rapid treatment (START ) is a triage method used by first responders to quickly classify victims during a mass casualty incident (MCI) based on the severity of their injury.

Red      = immediate - critical patient

Yellow = delayed - serious patient that could wait until all reds have been transported

Green   = ambulatory / hold – minor injuries

Black    = deceased (expectant)



START – 4 things to think about…

• Ability to follow directions and walk 
• Respiratory effort 
• Pulses/perfusion 
• Mental status

START Triage, evaluate victims and assign them to one of the following four categories:

• Walking wounded/minor (green) 
• Delayed (yellow) 
• Immediate (red) 
• Deceased/expectant (black) 

BEGIN…

1. Clear out all ambulatory patients – tag Green
2. Rest of the patients require MORE triage – 3 steps: They will be either red, yellow or black.

Step 1 Respiratory Effort

1. Not breathing – manually open their airway. If they start Breathing - tag RED
2. Breathing >30 or <10 = tag RED
3. If they don’t start breathing – tag BLACK
4. Breathing normal 10-30 = go to next step

Step 2 Pulses/Perfusion

1. Check for Radial pulse.
2. Radial pulse absent = tag RED
3. Radial pulse present = go to next step

Step 3 Mental Status

You are assessing whether or not the person can follow a simple command. “Squeeze my hand”

1. Can follow a simple command = tag YELLOW
2. Cannot follow a simple command = tag RED

JUMPSTART Pediatric Modifications for START

Kids Are A Little Different , Expect children to be part of a disaster
JumpStart – modified START for kids , Designed for children ages 1-8 y/0

Respiratory effort – not breathing

1. Open the airway , If the patient starts breathing tag RED
2. If apneic and no pulse tag BLACK
3. If apneic with pulse try 5 rescue breaths , If still apneic tag BLACK
4. If starts breathing tag RED

Respirations < 15 or > 45 tag RED
Respirations 15-45 go to next step (Pulse)

Pulse , No distal pulse – tag RED
Pulse present go to next step (Mental)

Mental status – use AVPU

1. Alert, responds to verbal or responds to pain = tag YELLOW
2. Inappropriate response, posturing or unresponsive tag RED

All Babies Under 1 Year Get Secondary Triage (Meaning No Greens).